Nursing Diploma to BSN | Facts and Rumours

by Khalil Ahmed Jatt and Dr Raisa Gul

Most of the nursing education institutions, in Pakistan, have been offering 3-year General Nursing Diploma since their establishment. The 4-year Bachelor of Science in Nursing (BScN) degree programme was introduced in the country in 1997 and the first cohort of BScN nurses graduated in 2001. Since then, many nursing institutions (schools or colleges) gradually switched to the degree programme, but the diploma programme was not abolished in the country.

The issue of abolishing the diploma became a topic of hot discussion when the Pakistan Nursing Council (PNC) stopped the nursing institutions to enroll students in the diploma programme in January 2019. Although most of the stakeholders are welcoming this announcement, some are raising their concerns against this move. Some rumours and misconceptions are also circulating in this regard. By distinguishing the facts from the rumours, the stakeholders can contribute towards a smoother transition from diploma to BSN degree and pave the way towards a better nursing and healthcare system for people of Pakistan.

Few of the most common concerns regarding abolishing the diploma programme are as follows:

1. Instead of a gradual transition, the diploma has been stopped suddenly
2. The degree programme is longer than the diploma programme.
3. The student nurses will not be available for duties in hospitals
4. The future of diploma holders will be at stake
5. There will be a shortage of nurses in the country

Is this a sudden decision?

The most frequently raised concern of above all is based on the belief that abolishment of diploma by PNC is too sudden and there should be a gradual transition from diploma to degree. Based on this concern, every rational thinker would oppose this act of PNC, but only if they do not have the factual background information.

Actually, the efforts and developments towards BScN degree in Pakistan had begun in the 1970s. Later, in the year 2000, Vision-2020 was developed to have all nurses entering the profession with an undergraduate degree instead of the diploma. The decision for this vision is grounded in extensive evidence that availability of BScN prepared nurses contribute to reducing patient morbidity and mortality (Akin et al., 2003). Moreover, if nurses to be at par with other healthcare professionals including medicine, pharmacy, and physiotherapy, they must enter their profession with a degree instead of a diploma. In 2015, the Higher Education Commission (HEC) of Pakistan had clearly notified that the diploma will not be recognized after2018. This announcement was further elaborated via a notification by PNC, which stated that there will be no admissions in the general nursing diploma program after 2018. Therefore, it is evident that the decision to stop nursing diploma has not been taken suddenly.

پاکستان میں نرسنگ ڈپلومہ کو ختم کر کے ڈگری پروگرام شروع کرنے کا خیال 1970 کی دہائی سے چل رہا ہے۔ سن 2000 میں بننے والے وژن 2020 میں بھی ایسا ہی کرنے کا عظم کیا گیا۔ جبکہ 2015 اور 2016 میں ایچھ ای سی اور پی این سی نے بھی نوٹیفیکیشن جاری کئیے کہ 2018 کے بعد ڈپلومہ میں داخلے نہیں ہونگے۔ کسی بھی صورت یہ فیصلہ اچانک نہیں لیا گیا۔

Is the duration of BSN longer than the nursing diploma?

Some people also think that the degree programme is longer than the diploma as they only consider the three-year general nursing programme. However, most of the female nurses do one-year midwifery diploma straight after the nursing diploma, so they require four years in their training. Furthermore, in most institutions, the majority of candidates who apply for nursing diploma program have an intermediate certificate (FSc); but, their education goes unrecognized because the minimum requirement for the diploma is Matriculation. These candidates will be advantaged if offered a BScN degree.

The BSN also needs 4-years of schooling. However, diploma nurses are provided RN license after they pass their Provincial Board exam. This usually takes a few months. Whereas the BScN students do a one-year internship. The internship programme has been introduced based on evidence from national and international research (Beecroft, Kunzman, & Krozek, 2001; Gul, 2007; Lalani & Dias 2011; Ulrich et al., 2010). Findings of these studies revealed that BScN graduates experience high anxiety in their RN role without due preparation. Recommendations suggested that similar to the MBBS programme, an internship period should be introduced for a smoother transition from the student to RN role as well as for better retention of the graduates and enhanced patient safety.

ڈپلومہ کرنے والوں کو ڈپلومہ کرنے کے بعد ایک سالہ مڈوائفری یا اسپیشلائیزیشن بھی کرنی پڑتی ہے . اس طرح ڈپلومہ اور بی ایس این دونوں میں چار سال ہی لگتے ہیں. جبکہ بی ایس این والوں کی ایک سالہ انٹرنشپ بھی کرنی پڑتی ہے جو کہ کافی فائدہ مند ثابت ہوئی ہے. اس کے علاوہ زیادہ تر اداروں میں ڈپلومہ میں داخلے ایف ایس سی کے بعد ہوتے ہیں لیکن نرسنگ ڈپلومہ پھر بھی ایف ایس سی کے برابر تصّور ہوتا ہے. جبکہ بی ایس این ڈگری کا انتخاب کر کے ایک بین الاقوامی  سطح کی ڈگری حاصل کی جا سکتی ہے.

Will the transition from diploma to BSN cause shortage of student nurses in hospitals?

Another common concern is that stopping the diploma programme will create a shortage of student nurses working in hospitals. Whereas, one may notice that this concern is also invalid. Since nursing is an applied discipline, students of BSN must do clinical duties as per the PNC requirement. In addition to the clinical rotations during the course of study, they also have to perform a mandatory internship for one year. It will also be a source of workforce for the hospitals. However, efforts should be concentrated to ensure that all interns of BSN are paid. The supreme court has recently ordered that there will be no unpaid internship (house job) for the MBBS graduates. The same rule should be applied for BSN graduates as well.

ڈپلومہ پروگرام بند کرنے سے ہسپتالوں میں سٹوڈنٹ نرسز کی کوئی کمی نہیں ہوگی۔ بلکہ چار سالہ پڑھائی کے بعد بی ایس این گریجوئیٹس کو ایک سالہ انٹرن شپ بھی کرنی ہوگی جس کی وجہ سے انٹرن بھی ہسپتالوں میں کام کریں گے۔

What would be the future of diploma nurses?

A major concern raised by some nursing professionals is that the future of diploma holders will be at stake. In fact, there will be no issue for the diploma holders. Those who are already working in healthcare organizations will continue to work in the same capacity. Diploma holders already have the option to get a BScN degree in only two years. That degree is called Post-RN BScN. Post-RN BScN is considered equivalent to 4-year BScN by the HEC, Pakistan, and abroad too. Like 4-year BSN, Post-RN BScN graduates can also proceed for MSCN degree. Most PhD nurses in Pakistan have followed this route.

Those nursing students who are currently studying for the general nursing diploma will also duly get registration with PNC and can apply for jobs as registered nurses. There is no change in the eligibility criteria to become a registered nurse neither there is any plan to change the criteria in the near future.

ڈپلومہ پروگرام میں مزید داخلے بند ہو گئے ہیں لیکن ڈپلومہ ہولڈر نرسز کے نقصان میں کوئی پالیسی نہیں بنی ہے اور نا ہی مستقبل قریب میں ایسی کوئی پالیسی بنانےکا منصوبہ ہے۔ جبکہ پوسٹ آر این بی ایس این کی صورت میں ڈپلومہ ہولڈر نرسز کے پاس پہلے سے ہی اپنی تعلیمی قابلیت بہتر کرنے کا موقع بھی موجود ہے۔

Will this transition cause shortage of nurses?

Many believe that in case of abolishing the diploma programme, there will be a shortage of nurses in the country. However, the matter of fact is that the number of seats for the BScN programme is increasing along with the number of new degrees awarding institutions. Moreover, as per the plan, the institutions offering diploma will be facilitated by the government to start the BSN programme. Therefore, the transition from diploma to degree will eventually not cause a shortage of nurses. But the graduates of BSN who have gone through rigorous studies and a licensure examination will be able to deliver better care. These graduates will also uplift the image of the nursing profession. A positive image of nursing will attract more people to join the profession.
read more: What is PNC Licensure Exam and Why is it Necessary?

ڈپلومہ ختم کرنے سے نرسز کی کوئی کمی نہیں ہوگی۔ بلکہ بی ایس این کی سیٹیں بھی بڑھ رہی ہیں اور ڈگری دینے والے ادارے بھی بڑھائے جا رہے ہیں۔ جس سے پاکستان میں نرسز کی تعداد بڑھنے کے ساتھ ساتھ نرسنگ کا معیار پہلے سے بہتر ہوگا۔

What if students are enrolled in the diploma programme after the year 2018?

It is very important to notice that if any students are inducted in the diploma after the year 2018, HEC will not recognize their qualification. Hence, the future of those students will be at stake. HEC equivalence issue remained a source of distress for many nursing professionals for years. Induction of students in the diploma programme in any month of the year 2019 or beyond will create serious problems for those students as their education will not be recognized by HEC.

سال 2018 کے بعد اگر ڈپلومہ پروگرام میں داخلے کئیے گئے تو یہ ان طلبہ کے ساتھ زیادتی ہوگی۔ کیوں کہ ہائر ایجوکیشن کمیشن ان طلبہ کی کی تعلیم کو تسلیم نہیں کرے گا۔

In brief, the abolishment of the diploma programme is not a sudden decision. The move will not cause any shortage of nurses or nursing student. The future of diploma holders or currently enrolled in the program is also safe as they have the option to get a degree in the form of Post-RN BScN. 

Upgrading the nursing education from diploma to the degree programme is an excellent opportunity to upgrade the nursing profession. Moreover, nurses with BScN is a must to reclaim the lost share of Pakistani nurses in the international market. Recently, most of the Pakistani nurses working abroad are sent back to Pakistan because they had only a nursing diploma and not a BSN degree which is a requirement of this era. There will always be excuses to continue the diploma. If the diploma programme is not be stopped now, it will never be. 

References:

Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290, 1617-1623.

Beecroft, P. C., Kunzman, L., & Krozek, C. (2001). RN internship: outcomes of a one-year pilot program. Journal of Nursing Administration, 31, 575-582.

Gul, R. B. (2007). Competence of Graduates of the Four-Year BScN Programme at Aga Khan University: Experiences and Perceptions. Doctoral dissertation, University of Alberta, Edmonton, AB.

Lalani, N.S., & Dias, J.M. (2011). The Role Transition of Nurses in a University Teaching Hospital in Pakistan. Journal for Nurses in Staff Development, 27(4), E1-E5.

Ulrich, B., Krozek C, Early, S., Hipps, C., Ashlock, C.H., Africa, L.M., & Carman, M.L. (2010). Improving Retention, Confidence, And Competence of New Graduate Nurses: Results from a 10-Year Longitudinal Database SERIES. Nursing Economic$, 28 (6), pp. 363-375.